Deregulating emergency contraception: The alternative may be unwanted pregnanciesBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6921.135 (Published 08 January 1994) Cite this as: BMJ 1994;308:135
EDITOR, - Lawrence Mascarenhas's response 1 to James Owen Drife's editorial repeats some of the many oft quoted fallacies about emergency contraception.
Firstly, there is no evidence that the “Yuzpe” regimen carries a risk of ectopic pregnancy. only one case has been reported in the world literature; this was in a woman who had established tubal disease.2 The story probably derives from people's concern when the old method of giving 5 mg ethinyloestradiol for five days was used, but it has no place with current practice in Britain.
Secondly, there is not even a theoretical risk of teratogenesis as at the very early stages of development cells are totipotential; if a few die they are replaced by mothers, which are still totipotential. If many are affected pregnancy cannot be established.3 The Faculty of Family Planning and Reproductive Health Care is collecting details of pregnancies that go to term despite the Yuzpe regimen being used and confirms that the rate of congenital abnormalities is not increased above the background rate. Anyone who knows of such a case should inform the faculty, care of the Royal College of Obstetricians and Gynaecologists.
Thirdly, there is no evidence of changes in clotting factors after use of the Yuzpe regimen.4 which, after all, is only six days' worth of low dose pills. In a woman in whom there is a strong suspicion of an inherited clotting abnormality I suggest, however, that an intrauterine device should be used as the first choice of emergency contraception.
Fourthly, I wish to correct a common mistake made by Drife. Although 2-3% of women are expected to become pregnant after they take oral emergency contraception this does not mean that such contraception is 98% effective as many of the women would not have become pregnant anyway. It is difficult to calculate how many pregnancies are avoided, but the best estimate is that the Yuzpe regimen is 75% effective.5
The most recent guidelines on emergency contraception were published in the British Journal of Family Planning in 1992 and are obtainable from the faculty.
Availability of emergency contraception over the counter should be in addition to, not instead of, availability from medical services. There is also a need to train pharmacists, make sure they can provide privacy for questions, and make the package inserts clear.